Acute Kidney Injury After Cardiac Transplantation: Foe or Common Innocent Bystander?

Romeo, Francisco; Varela, Carlos Federico; Vulcano, Norberto; Pizarro, Rodolfo; Greloni, Gustavo; Posatini, Ricardo; Marenchino, Ricardo; Rosa-Díez, Guillermo; Belziti, César

doi:10.1016/j.transproceed.2018.03.106

Cited by 21 publications

(26 citation statements)

References 37 publications

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“…This is similar to previous studies reporting a need for RRT in 6-29% of patients [2,4,6]. A recent analysis indicated that AKI requiring RRT had a 1-year mortality rate of 59.2% [16]. In Boyle's study, AKI requiring RRT was associated with a mortality rate of 50% compared to 1.4% in patients without AKI [17].…”

Section: Discussionsupporting

confidence: 87%

Incidence, Risk Factors and Clinical Outcomes of Acute Kidney Injury after Heart Transplantation: A Retrospective Single Center Study.

Jiang

Kong

2020

Preprint

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Objectives This study aimed to identify the incidence rate of Acute kidney injury (AKI) in our center, assess risk factors for one-year mortality, and predict short- and long-term survival after heart transplantation (HTx). Methods This single-center, retrospective study from October 2009 to Jan 2020 analyzed the pre-, intra-, and postoperative characteristics of 87 patients who underwent HTx. AKI was defined according to the Kidney Disease: Improving Global Outcomes (KDIGO) criteria. Risk factors were analyzed by multivariable logistic regression models. The log-rank test was used to compare long-term survival. Results Twenty-six (36.1%) patients developed AKI. The one-year mortality rates in HTx patients with and without AKI were 26.92% and 10.87%, respectively (P > 0.05). Recipients who required renal replacement therapy (RRT) had a one-year mortality rate of 53.85% compared to 10.87% in those without AKI or RRT (P = 0.003). A long cardiopulmonary bypass (CPB) time (OR: 1.622, 95% CI: 1.014 to 2.595, P = 0.044) was positively related to the occurrence of AKI. A high intraoperative urine volume (OR: 0.566, 95% CI: 0.344 to 0.930, P = 0.025) was negatively correlated with AKI. AKI requiring RRT (HR, 6.402; 95% CI, 2.014–20.355, P = 0.002) was a risk factor for death. Overall survival in patients without AKI at 1, 3, and 5 years was higher than that in patients with AKI (P > 0.05). Conclusions AKI is common after HTx and adversely impacts early mortality. A long CPB time and low intraoperative urine volume maybe associated with the occurrence of AKI. AKI requiring RRT could contribute powerful prognostic information to predict short-term survival.

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Section: Discussionsupporting

confidence: 87%

Incidence, Risk Factors and Clinical Outcomes of Acute Kidney Injury after Heart Transplantation: A Retrospective Single Center Study.

Jiang

Kong

2020

Preprint

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“…Subsequently, 94 studies were excluded as these studies did not have data on the incidence or mortality of AKI, 77 articles were additionally excluded because they were not observational studies or clinical trials, and 9 studies were excluded because they did not utilize a standard AKI definition or did not describe the incidence of AKI requiring RRT. Finally, 27 cohort studies [8,[18][19][20][31][32][33][34][35] with 137,201 patients undergoing cardiac transplantation were identified. The flowchart of this study is shown in Figure 1.…”

Section: Resultsmentioning

confidence: 99%

“…Reported risk factors for AKI in patients undergoing cardiac transplantation are shown in Table 3. Preoperative risk factors including chronic kidney disease (CKD) [8,19,36,43,51], diabetes mellitus (DM) [36,43], and older age [19,41,52]. were consistently demonstrated as associated risk factors for AKI in patients after cardiac transplantation.…”

Section: Discussionmentioning

confidence: 99%

“…Despite tremendous advances in the field of cardiac transplant medicine and surgical techniques, there is a paucity of data on the incidence, associated risk factors, and mortality risk of AKI in patients undergoing cardiac transplantation. In addition, the incidence of AKI among patients undergoing cardiac transplantation is not uniformly described among studies, ranging from 40% to 70% [18][19][20][21][22][23].…”

Section: Introductionmentioning

confidence: 99%

“…Included studies in this systematic review of AKI incidence and mortality in patients undergoing cardiac transplantation [8,[18][19][20][31][32][33][34][35]…”

mentioning

confidence: 99%

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Acute Kidney Injury in Patients Undergoing Cardiac Transplantation: A Meta-Analysis

et al. 2019

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Background: Acute kidney injury (AKI) is a common complication following solid-organ transplantation. However, the epidemiology of AKI and mortality risk of AKI among patients undergoing cardiac transplantation is not uniformly described. We conducted this study to assess the incidence of AKI and mortality risk of AKI in adult patients after cardiac transplantation. Methods: A systematic review of EMBASE, MEDLINE, and Cochrane Databases was performed until June 2019 to identify studies evaluating the incidence of AKI (by standard AKI definitions), AKI requiring renal replacement therapy (RRT), and mortality risk of AKI in patients undergoing cardiac transplantation. Pooled AKI incidence and mortality risk from the included studies were consolidated by random-effects model. The protocol for this study is registered with PROSPERO (no. CRD42019134577). Results: 27 cohort studies with 137,201 patients undergoing cardiac transplantation were identified. Pooled estimated incidence of AKI and AKI requiring RRT was 47.1% (95% CI: 37.6–56.7%) and 11.8% (95% CI: 7.2–18.8%), respectively. The pooled ORs of hospital mortality and/or 90-day mortality among patients undergoing cardiac transplantation with AKI and AKI requiring RRT were 3.46 (95% CI, 2.40–4.97) and 13.05 (95% CI, 6.89–24.70), respectively. The pooled ORs of 1-year mortality among patients with AKI and AKI requiring RRT were 2.26 (95% CI, 1.56–3.26) and 3.89 (95% CI, 2.49–6.08), respectively. Conclusion: Among patients undergoing cardiac transplantation, the incidence of AKI and severe AKI requiring RRT are 47.1% and 11.8%, respectively. AKI post cardiac transplantation is associated with reduced short term and 1-year patient survival.

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A contemporary simple risk score for prediction of severe acute kidney injury after heart transplantation

Zhu,

Qiao,

Wang

et al. 2024

ESC Heart Failure

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BackgroundThe aim of this study was to develop a simple risk score to estimate severe acute kidney injury (AKI) risk based on a large contemporary heart transplantation (HT) cohort.MethodsFrom 1 January 2015 to 31 December 2021, all consecutive HT recipients in our institute were included and analysed for the occurrence of AKI within the first seven postoperative days. Patients transplanted between 2015 and 2019 comprised the derivation cohort, and those transplanted between 2020 and 2021 formed the validation cohort. The primary endpoint was severe AKI (AKI stages 2–3). The impact of severe AKI on 90 day mortality was also evaluated.ResultsOverall, 430 HT patients were included in the derivation cohort, and 108 were included in the validation cohort. Postoperative AKI occurred in 388 (72%) patients, including 162 (30%) severe AKI. The risk of 90 day mortality significantly increased in patients with severe‐AKI. Seven independent predictors of severe AKI were found in the derivation cohort, including recipients' body mass index, history of diabetes, anaemia, preoperative inotropes, estimated glomerular filtration rate, cardiopulmonary bypass duration and intraoperative red blood cell transfusion. The occurrence of severe AKI increased gradually from the lowest to the highest of the four risk score groups in the derivation and validation cohort. The scoring prediction model showed a highly acceptable discriminating power for severe‐AKI [C statistic: 0.76, 95% confidence interval (CI): 0.71–0.80 for derivation cohort; C statistic: 0.79, 95% CI: 0.71–0.89 for validation cohort].ConclusionsA contemporary simple risk score based on available variables from patients undergoing HT can accurately discriminate the risk of severe AKI.

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Acute Kidney Injury After Cardiac Transplantation: Foe or Common Innocent Bystander?

Cited by 21 publications

References 37 publications

Incidence, Risk Factors and Clinical Outcomes of Acute Kidney Injury after Heart Transplantation: A Retrospective Single Center Study.

Incidence, Risk Factors and Clinical Outcomes of Acute Kidney Injury after Heart Transplantation: A Retrospective Single Center Study.

Acute Kidney Injury in Patients Undergoing Cardiac Transplantation: A Meta-Analysis

A contemporary simple risk score for prediction of severe acute kidney injury after heart transplantation

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